Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements.

Methods: For this feasibility study a small sample size of 14 participants (3 – 60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n=7) or wait list control (n=7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies.

Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Aiming at the hand rehabilitation of stroke patients, a wearable hand exoskeleton with circuitous joint is proposed. The circuitous joint adopts the symmetric pinion and rack mechanism (SPRM) with the parallel mechanism. The exoskeleton finger is a serial mechanism composed of three closed-chain SPRM joints in series. The kinematic equations of the open chain of the finger and the closed chains of the SPRM joints were built to analyze the kinematics of the hand rehabilitation exoskeleton.

The experimental setup of the hand rehabilitation exoskeleton was built and the continuous passive motion (CPM) rehabilitation experiment and the test of human-robot interaction force measurement were conducted. Experiment results show that the mechanical design of the hand rehabilitation robot is reasonable and that the kinematic analysis is correct, thus the exoskeleton can be used for the hand rehabilitation of stroke patients.

What if your watch could alert you to a seizure ahead of time so you could get to safer ground or ask someone to call 911? Or if a wristband could detect changes in the progression of your Parkinson’s disease, allowing your doctor to adjust your treatment plan? What once seemed like science fiction is now reality for more patients with epilepsy and other neurologic disorders, as wearable electronic monitoring and alert devices paired with mobile phone apps enter the market.

Unlike old-fashioned methods of data collection, which rely on handwritten patient logs and calendars, these wristbands and smartphone apps record events and changes in real time, revealing a more comprehensive and objective portrait of daily symptoms. “With this more precise information, we can often spot problems even before a patient is aware of them,” says Joseph I. Sirven, MD, a professor of neurology at the Mayo Clinic in Phoenix, AZ, a Fellow of the American Academy of Neurology (FAAN), and a member of the Neurology Now editorial advisory board.

The first generation of these devices was developed for patients with epilepsy, both by researchers and by small startup companies or garage-based operations whose founders had a loved one with the condition. Early prototypes alerted family members via smartphone that a seizure was happening. Today, more sophisticated devices can detect impending seizures or track changes in walking and other symptoms in patients with movement disorders.

In a recent conversation with my fellow TBI survivors, we were discussing ways that people can reach out and help us. The first few months after a concussion or traumatic brain injury (TBI) are critical. I know for myself personally, when I look back at the first six months I can see how completely dazed and confused I was.

However, the recovery from a TBI can last months to years. Every single brain injury is unique, and will not only take different recovery times, but will also present different symptoms depending on where the brain was injured. There is no “magic formula” and I know of those with severe TBI who fully recovered in a few years, while others with a mild TBI are still recovering many years later.

A TBI is much like a fingerprint or snowflake, no two are alike.

In addition, many “outsiders” have no idea what kind of hell we are going through. They hear the word “concussion” and think it’s not big deal. Or they hear the term “traumatic brain injury” and can only imagine the most severe (think coma, bed ridden, not able to speak or walk) and figure if we’re walking and talking then we must be doing “OK.” Neither of these scenarios are correct, and I beg of you to try to understand what we’re going through. At the very least, I offer you some suggestions on how to help us cope with this stressful and frustrating time of our life.

Don’t ask them what they need. We may not actually know “what” we need. Or we may feel embarrassed and don’t want to be a burden or seem needy. Don’t ask us if we’d like you to come over. We’ll likely say no, but really mean yes. Just show up at our door with open arms.

A possible treatment for traumatic brain injury (TBI) could be the use of a specific high-powered, near-infrared light (NIR), a new study suggests.

The study was published recently in the journal Neuropsychiatric Disease and Treatment, according to a media release from the Neuro-Laser Foundation.

Study co-authors Theodore Henderson, MD, PhD from the Neuro-Laser Foundation and Dr Larry Morries and Paolo Cassano of Massachusetts General suggest that a specific high-powered, near infrared light (NIR) can possibly re-energize damaged brain cells after penetrating the skin and skull, per the release.

In their study, which occurred from 2011 to 2013, the research team administered 10 transcranial applications of high-power NIR over the course of 2 months to 10 study participants who were diagnosed with chronic mild-to-moderate TBI. Using a Class IV laser and pulsed light, each treatment took less than 60 minutes, the release explains.

Magnetic pulses from a device applied to the head appear to “reset” the brains of depressed patients, according to a new study from the United Kingdom. The circuitry in a part of the right prefrontal cortex is known to be too active in depressed patients, causing excessive rumination and self absorption and impaired attention. When the TMS was applied to healthy subjects in this study, the activity in that region slowed. “We found that one session of TMS modifies the connectivity of large-scale brain networks, particularly the right anterior insula, which is a key area in depression,” lead scientist Sarina Iwabuchi, told the European College of Neuropsychology at a conference in Amsterdam this week. This was the first time an MRI was used to guide the TMS impulses and, at the same, time measure subtle changes in brain circuit activity. In addition, the researchers used magnetic resonance spectroscopy to analyze subjects’ brain chemistry.

Braddom’s Physical Medicine and Rehabilitation

The most-trusted resource for physiatry knowledge and techniques,Braddom’s Physical Medicine and Rehabilitationremains an essential guide for the entire rehabilitation team. With proven science and comprehensive guidance, this medical reference book addresses a range of topics to offer every patient maximum pain relief and optimal return to function.

In-depth coverageof the indications for and limitations of axial and peripheral joints through therapies enables mastery of these techniques.

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New lead editor– Dr. David Cifu – was selected by Dr. Randall Braddom to retain a consistent and readable format. Additional new authors and editors provide a fresh perspective to this edition.

When it comes to choosing surgery or physical therapy for carpal tunnel syndrome (CTS), studies have found most people would rather pursue a conservative approach. Now new research from Spain is providing more support for that preference, concluding that in terms of pain and function, physical therapy is equal to surgery at 6 and 12 months after baseline, and actually produces greater improvements earlier on.

In a study e-published ahead of print in the Journal of Pain (abstract only available for free) researchers compared pain and function reports from 111 women who underwent either surgery (56 participants) or physical therapy (55 participants) for CTS. Using the Numerical Pain Rating Scale (NPRS), Boston Carpal Tunnel Questionnaire (BCTQ), and the Global Rating of Change assessment, they analyzed reports at 1, 3, 6, and 12 months after surgery or therapy.

The study found that when it came to self-reported current level of pain and worst pain over the preceding week, the physical therapy participants reported higher decreases on the 11-point pain scale at 1 month (an average 2-point difference from the surgery group) and at 3 months (an average 1.3-point difference). By 6 months, those differences had lessened and were practically nonexistent after 1 year.A similar pattern was uncovered when researchers analyzed BCTQ data, with the physical therapy participants registering significant improvements compared with the surgery group in the first month, decreased but notable differences in month 3, and minimal differences at 6 and 12 months.

Physical therapy used in the study was composed of manual therapies that included desensitization maneuvers of the central nervous system—primarily soft tissue mobilization and nerve/tendon exercises “including manual techniques directed at anatomical sites of potential entrapment of the median nerve,” according to authors. Participants received 3 30-minute treatment sessions provided once a week, and a final educational session on doing the exercises as homework.The surgery group underwent open or endoscopic decompression and release of the carpal tunnel, with the approach based on the preferences of the patient and surgeon. Patients in this group also received the same educational session on the tendon and nerve gliding exercises provided to the physical therapy group.

Authors of the study point out that their study differs from previous research that found surgery to produce greater improvement at 6 and 12 months—a difference they attribute to the kind of physical therapy used for the intervention.”Our results on the physiotherapy arm could have been better than those of prior reports because we have applied manual therapies including desensitization maneuvers of the central nervous system,” they write. ”

Approaches including integrative manual therapies may be more effective than therapeutic interventions targeting only the hand/wrist area, but testing this hypothesis requires further randomized clinical trials.”The real point, according to authors, is that their study supports not only the public’s preference for conservative approaches to CTS, but guidelines from the American Academy of Orthopaedic Surgeons (AAOS).”It seems conservative management may be considered as a front-line treatment in mild to moderate, and sometimes severe, cases of CTS before subsequently considering surgery,” authors write.

Stroke results in impairment of motor, cognitive and sensory/perceptual functions. As such, activities of daily living (ADL) after stroke can be affected. These affectations can persist for a long time depending on the extent of the affectation in the brain and rehabilitation. In fact, stroke has lately been recognized as a long term condition. Thus, stroke rehabilitation requires intensive time.

When stroke occurred, the brain capitalizes heavily on learning to recover function; and the best way to induce such learning is known to be through task specific training. Effective stroke rehabilitation requires knowledge of the current available evidence base. However, to embrace the current available evidence, skills in information retrieval and critical appraisal of the literature are needed.

Unfortunately, the skills of a say, entry level physiotherapists may not be adequate for them to be abreast of the evidence-based practice. Thus, there is a need to summarize the literature for such therapists to help them note some important issues in stroke rehabilitation.

The aim of this small case series was to demonstrate the training effects of a three-week robotic leg orthosis, and to investigate possible mechanisms of the sensory-motor alterations and improvements by using gait analysis and EMG.

Three survivors of chronic strokes participated in robot-assisted gait therapy for three weeks. EMG signals from the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG), as well as kinetics and kinematics data of the lower limb, were recorded before and after the training. The normalized root mean squared (RMS) values of the muscles, the joint moments, joint angles, and the results of two clinical scales (Berg Balance scale, BBS, and the lower extremity subscale of Fugl-Meyer assessment, LE-FMA) were used for analysis. All participants experienced improved balance and functional performances and increased BBS and LE-FMA scores.

The EMG results showed there was an increase of the normalized RMS values of the MG and BF on the affected side. Additionally, EMG activities of the agonist and antagonist pair (i.e. RF and BF) appeared to return to similar levels after training. The peak moment of hip flexor, knee extensor, and plantar flexor, which all contributed to push-off power, were found to have increased after training.

In summary, the three-week training period using the wearable RLO improved the three participants’ gait performance by regaining push-off power and improved muscle activation and walking speed.